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Monday, January 29, 2007

(HealthDay News) -- The initial economic cost of having a baby born with a birth defect is enormous, ranging from several thousand dollars to several hundred thousand dollars per child.So concludes a study published in the Jan. 19 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

Researchers found that cardiovascular, gastrointestinal and musculoskeletal defects quickly run up the highest hospitalization bills.

"This study is a very important slice of the pie in terms of how expensive birth defects are," said Dr. Nancy Green, medical director of the March of Dimes. "It's important in terms of helping to define some of the costs associated with birth defects, and as a way to remind the public that birth defects are fairly common and are very expensive in terms of dollars -- and of heartache."As many as one in 33 babies born in the United States has a birth defect, according to the Agency for Healthcare Research and Quality (AHRQ). Birth defects are believed to generally occur during the first three months of pregnancy, often before a woman is even aware she is expecting.

The exact cause of many birth defects is unknown, but Green said they are presumed to occur as a complex interaction between the genetic predisposition of the fetus and "some sort of broadly defined environmental impact."

These defects can vary significantly in their severity. Some are mild. Others can cause the death of the baby soon after birth.

The current study included 2003 hospital data on 35 selected birth defects. The birth defects were chosen based on whether or not the condition could be diagnosed at birth and if it was a permanent condition without intervention.

The conditions responsible for the most in-hospital deaths during the study period were diaphragmatic hernia (protrusion of the stomach through the diaphragm), renal agenesis (absence of one or both kidneys), trisomy 18 (a serious birth defect in which there are three copies of chromosome 18), and several congenital heart defects.

Costs varied widely, depending on the birth defect. Overall, the most expensive birth defect was an obstructive genitourinary defect, which resulted in almost $365 million in hospital charges. This defect, which is a narrowing or an absence of certain urinary tract structures, is fairly common. About 13,000 babies were born with it, according to the study. Individually, the cost to fix this problem is about $28,000.

Surgeries to correct defects of the heart were among the most costly per procedure, often running to more than $100,000 per child.

In all, birth defects lead to more than $2.5 billion a year in hospital costs alone, according to the study.

"It's interesting that someone took a broad look at the costs," said Dr. Dan Polk, a neonatologist with Children's Memorial Hospital in Chicago. But, he said, one problem with this information is that there's not much you can do to change these figures unless more money is invested in research to discover what causes these defects in the first place.

Until doctors understand the origins of specific birth defects, it's difficult to suggest prevention strategies, other than get early prenatal care and follow your doctor's advice for a healthy pregnancy.

"OK, so we know these defects cost money, but how do you prevent the spending of that money? Nothing's known on how to prevent these birth defects. They're there, and it is what it is. It's not a lifestyle issue or a mother's issue," said Polk. "Research defining the underlying causes might allow us to prevent, rather than try to treat, these birth defects."

Green agreed that more research is critical and pointed out that research has already led to the elimination of some birth defects.

"In the 1960s, a lot of pregnant women got rubella. If that's acquired for the first time by a pregnant mom in the last trimester, it can cause congenital rubella syndrome. Thanks to standard routine vaccinations, we don't see that anymore," said Green.

Both Green and Polk recommended that all women of childbearing age make sure they get 400 micrograms of folic acid daily, because a deficiency in folic acid can lead to neural tube defects such as spina bifida in babies.

Green also suggested that if you can possibly plan your childbearing to occur before age 35, you can lower your risk of having a child with a birth defect.

"As a woman ages, there's a greater chance of having a pregnancy affected by chromosomal abnormalities," she said.

Green also pointed out that the costs of birth defects hardly end with initial hospitalizations. The AHRQ recently released a report on the cost of birth defects and found that the average age of people being treated for birth defects was 17 years old, she said.

"While many of these birth defects are treated in infancy, the impact of birth defects can be long-lasting and may extend into adulthood," Green noted.

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